Health

Mammogram Miscues

Why confusion remains over changed guidelines

The controversial and often confusing argument over when a woman should have her first screening mammogram has taken yet another turn. This turn, however, may lead to agreement.

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The president of the American College of Obstetricians and Gynecologists is trying to streamline the medical community’s advice. Dr. Mark DeFrancesco announced he will be taking the lead in putting together what he called a “consensus conference” in January.

DeFrancesco shared the news with his fellow physicians in a letter sent to ACOG members.

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“Your patients, and you, may be understandably confused by the ever-changing variations of mammography,” the letter read.

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DeFrancesco also wrote the conference’s goal will be “to develop a consistent set of uniform guidelines for breast cancer screening that can be implemented nationwide.”

“If I hadn’t gotten mammograms, I could be dead. That’s all that I kept thinking about when I saw the guidelines had changed.”

In the meantime, though, ACOG’s advice hasn’t changed.

“We still recommend annual screening for women starting at age 40, along with clinical breast exams,” he wrote.

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In October, the American Cancer Society shook up the medical community by announcing that most women can start annual screenings at age 45, versus age 40, and every other year after the age of 55.

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The U.S. Preventive Services Task Force recently reinforced its 2009 guidelines. The federal panel advised women in their 40s to talk to their doctors about the benefits and potential harms before deciding to get screened.

These changing guidelines are making many breast cancer survivors nervous, and even angry.

One Chester County, Pennsylvania, survivor who blogs about breast cancer is especially concerned.

No guideline should be a “one size fits all” approach.

“If I hadn’t gotten mammograms, I could be dead, and that’s all that I kept thinking about when I saw that the guidelines had changed,” 51-year-old Carla Zambelli told LifeZette.

Zambelli was diagnosed when she was 46, an age at which she would not have been screened under the new federal guidelines.

“I hate to be this way, but to me, that always makes me wonder if the basis is in the insurance company industry and what they want to pay for,” she told LifeZette.

Zambelli said she doesn’t know if the consensus conference will do any good, but she is glad to know the various organizations are trying to agree.

An ACOG spokesperson would not comment on how the conference planning is going, or what kind of feedback the group is getting in light of its announcement of a January meeting. But some physicians say they are appreciative of the effort.

The potential for agreement is good news for Dr. Amy Hearne, an OB-GYN who is licensed to practice in New York and Florida.

She, like the president of ACOG, acknowledged that the organizations all agree on the data. Where the groups disagree is how to interpret it.

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The sooner the guidelines are streamlined, the better, Hearne told LifeZette. She remembered how long it took for patients to adapt after the last big shift in screening recommendations.

“I would still have women who came in wanting a mammogram at 35,” she said. “It would take time before women understood that the baseline mammogram was really to start at age 40.”

For now, Hearne said she believes most gynecologists will continue to follow ACOG’s recommended guidelines and encourage screening mammograms at 40. However, she warns, no guideline should be a “one size fits all” approach.

There may also be a silver lining to the controversy and all of the attention it’s getting.

“It may at least start a conversation between doctors and patients,” Hearne said.

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